This invention relates in general to splints for fractures and in particular to splints associated with a fracture of the distal radius.
The proper setting of a fracture which will hopefully result in proper healing and rejoining of the bone sections may require a pin or other artificial device to be anchored into the bone sections so that the tendency of the bone sections to remain apart or misaligned can be overcome. Each bone fracture has its own unique alignment and healing aspects depending upon the bones which are involved, the size and health of the patient and the severity of the fracture. Fractures of the shaft or body portion of such bones as the femur, fibula, tibia, ulna and humerus can typically be set and will heal properly by means of an external plaster cast being applied. However, fractures in such areas as, for example, the neck of the femur or the proximal end of the ulna, usually necessitate the implanting of a pin or similar device in order to assure proper alignment of the bone sections during healing and to provide strengthening to the now-weakened bone portion.
The following listed patents provide a sampling of surgical apparatus designs associated with the setting of fractures which have been conceived.
______________________________________ U.S. Pat. No. Patentee Issue Date ______________________________________ 583,455 Bush 6/01/97 1,201,864 Overmeyer 10/17/16 1,789,060 Weisenbach 1/13/31 2,333,033 Mraz 10/26/43 3,244,170 McElvenny 4/05/66 3,835,849 McGuire 9/17/74 3,862,631 Austin 1/28/75 3,961,854 Jaquet 6/08/76 4,003,096 Frey 1/18/77 4,040,130 Laure 8/09/77 ______________________________________
Bush discloses a surgical apparatus especially designed for securing together severed sections of broken knee-caps. The apparatus includes two members which are independently anchored into opposite bone sections and are coupled together by a threaded member.
Overmeyer discloses a surgical appliance wherein a plurality of bone-engaging pins are disposed along a bar. The pins are slidably adjustable both along the bar and in the direction normal to the bar such that bone sections on opposite sides of a fracture can be manually drawn together.
Weisenbach discloses a bone fracture clamp wherein a plurality of pins are anchored into the bone sections on opposite sides of the fracture. These pins are secured to specially arranged clamp members which may be moved up or down the length of the pins. The clamp members are joined together by means of a universal joint such that the position of the pins on one side of the fracture can be altered relative to the position of the pins on the opposite side of the fracture.
Mraz discloses a bone splint wherein a plurality of worm gear and pinion gear arrangements are provided for a variety of motions and adjustments between two different block members which support anchoring pins that are inserted into bone sections on opposite sides of a fracture.
McElvenny discloses a compression-type bone splint wherein two members which are independently anchored into opposite bone sections such that the bone sections may be drawn together. The splint is designed to preserve forcible engagement of the bone sections independently and irrespectively of the contracting action of the related muscles.
McGuire discloses a bone clamp for aiding a surgeon in positioning bones and securing them together. The bone clamp includes means for properly orienting drills so that aligned holes may be drilled through the two bone sections associated with a particular fracture, whereafter a screw may be inserted through the bones to hold them together.
Austin discloses a surgical implant for use at a site of bone fracture, especially at an osteotomy site, to draw the two parts of bone together and hold them together during healing. The implant is in the form of a staple having two legs to be driven into the bone, one on either side of the fracture. The two legs can be moved toward each other by means of a nut, once they have been driven into the bone.
Jaquet discloses an apparatus for orienting and securing a rod in a spatially adjusted position. The apparatus includes a U-shaped element having opposed parallel branches and a bottom portion connecting the branches. At least two superposed plates are disposed between the branches and the plates having mating faces with grooves therein cooperatively defining a hole receiving a rod. A flange is detachably secured to the branches of the U-shaped element to hold the plates and rod between the branches. The top plate is connected to the flange for rotation about an axis parallel to the branches and the bottom plate is rotatable with respect to the U-shaped element about the same axis.
Frey discloses a wrist joint endoprosthesis for positioning between the proximal joint part and the distal joint part in order to permit increased hand movements.
Laure discloses a wrist joint prosthesis for use as a replacement for the joint in a human wrist and which permits vertical motion, sidewise motion and rotary motion, but preventing twisting motion about an axis projecting from and parallel with the lower forearm. For this purpose, there is provided a metal socket fitted with a prong receivable into a bone of the forearm. A plastic cup made of material self-lubricating with respect to such metal socket is fitted within said socket, snappable thereinto to resist but not prevent withdrawal therefrom. Although Frey and Laure are not splint-type apparata, they are cited for their showing of surgical-related apparata associated with the bones of the wrist and forearm.
Although each of these various devices may have provided an improvement to what was known in the art at the time of their conception, there still remain certain types of fractures which present unique problems to medical personnel, and these fractures require a unique splint arrangement in order to achieve success in the setting and healing of the fracture. Consider, for example, the problems associated with a fracture of the distal radius, such as a Colles' fracture. With such a fracture, deforming, resting and working forces produced by the forearm muscles whose tendons pass across the fracture site, must be neutralized by the splint if the splint is going to be suitable for the setting of the fracture. It is important to the setting of such a fracture that the splint have a structural arrangement suitable to restore optimal length to the dorsal and radial aspects of the distal radius through distraction forces. However, due to the anatomy of the forearm, wrist and hand, in order to restore optimal length to the radius, the application of distraction forces in three different planes or directions is required. It is equally important that the degree or level of force applied in each plane or direction be adjustable separately and relatively independently of one another such that change of one force setting in one plane or axis will not have any substantial influence on the settings in a different plane or axis. The first required distraction force is applied in the direction of the radius along an axis which lies in a substantially parallel relationship to the long axis of the radius bone. The second required distraction force is applied in a torsional manner about the pronation-supination axis and effects a twisting motion at the fracture site. The third required distraction force is applied in a plane corresponding to radial-ulnar deviation of the hand with respect to the forearm. Motion in this third plane restores optimal length to the radial and dorsal aspects of the distal radius. The presence of three different force planes or force directions which may be independently adjusted to alter the twist, angular orientation or length of one bone fragment relative to the other bone fragment permits independent manipulation of the distal fragment with respect to the proximal fragment and permits achievement of optimal length for the setting of the fracture. A further consideration is that the splint must be anchored in some manner on the distal side of the fracture site and the use of a metacarpal bone provides a suitable anchoring position. This means that the hand orientation must be considered and accommodated for the particular splint design if the splint is going to be suitable for setting the fracture.
None of the disclosed devices of the listed patents provide these various structural features. Although the patent of Weisenbach might be considered relevant, its disclosed structure does not provide selective adjustment in three different directions because as soon as the bolt is loosened, the universal joint is unrestrained in all directions as is the location of the bolt in the slot. Thus, while trying to achieve one adjustment in one direction, the prior adjustments which may have already been set are lost or are in some way altered. A suitable splint for the fracture of the distal radius is one in which sufficient distracting forces can be applied in a minutely adjustable manner such that the variation of patient and patient fractures can be universally accommodated by a single device. Furthermore, as previously discussed, it is quite important that the three different directions of distracting forces be capable of separate and independent adjustment so that the physician and medical personnel assisting with the surgery do not have to continuously adjust and readjust a setting which is either not fixed or is attached when a subsequent setting is made.